Hospital Errors No Longer Covered by Medicare

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

On October 1, 2008, Medicare will stop paying hospitals for conditions that could have been avoided through proper preventitive procedures. Among the eight specific conditons which will no longer be covered include procedures for retrieving sponges or surgical tools left inside a patient after operation, care for patients harmed by incompatible blood, air embolisms, bedsores, injuries caused by falls in hospitals, infections caused by prolonged use of catheters, or surgical site infections.

Purpose of health policy or idea

The main purpose of the policy change is to increase the quality of care recieved by patients in hospital settings and to save money which is spent treating preventable errors, injuries, and infections. The Institute of Medicine states that 99,000 people a year die from infections and complications incurred in hospitals. With Medicare ceasing to cover the extra costs of treating patients for these errors, hospitals will have to absorb these costs. This will likely result in systematic efforts from hospitals and staff to reduce errors and infections and improve patient care. Although it may cost more initially for performing more tests to assess the condition of patients at the time of admission, ultimately millions of dollars can be saved by preventing careless errors. The new policy is estimated to save Medicare substantially greater than $20 million.

Main points

Main objectives

The main objective of this policy change is to provide financial incentives to promote the goal of patient safety by making hospitals absorb the costs of errors made by hospital staff.

Type of incentives

By Medicare refusing to pay for hospital errors, the responsibility has shifted to the hospital and staff to pay for the hospital errors. The hospitals will most likely make efforts to reduce the rates of infections and preventable errors.

Groups affected

Medicare beneficiaries, hospitals, Federal Government

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

This new policy takes the initiative in addressing the problem of preventable medical errors. It aims to achieve and set a new standard of quality patient care. CMS must be cautious in assigning which conditions are indeed preventable so that hospitals are not penalized for conditions which are out of their control. However, the overall number of preventable medical errors should decrease with this new policy by making doctors and hospitals more alert and aware.  

Political and economic background

This change in health policy is in accordance with the overall national goal to improve the quality of care patients receive in hospital settings. This policy reform aims to decrease the number of patient deaths due to hospital errors and infections contracted in hospitals. Not only will this save Medicare approximately $20 million dollars a year, but it should also increase the quality of care patients receive.

According to the Centers for Medicaid and Medicare Services, in 2006 there were 322,946 pressure ulcers, 29,500 staphylococcus aureus bloodstream infections/ septicemia, 11,780 catheter-associated urinary tract infections, 764 objects left in patients during surgery, 45 air embolisms, and 33 cases of complications due to blood incompatibility. These are all occurences of the six preventable adverse effects that are targeted by the new policy proposed by the Centers for Medicare and Medicaid Services. These were all secondary diagnoses, although not necessarily acquired in the hospital.

Change of government

Medicare, the government funded insurance program for people 65 years of age and older, changed its policy and will no longer pay for extra costs of treating preventable errors, injuries, and infections that occur in hospitals.

Change based on an overall national health policy statement

The policy change states that Medicare will cease paying for specific preventable medical errors. This will shift the burden of costs of unnecessary medical procedures to the hospitals.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The rule which was proposed by the Centers for Medicare and Medicaid Services in August 2007 will go into effect in October 2008. This proposal was a response to the 2003 Medicare Modernization Act which requires the Secretary of Health and Human Services to examine hospital-acquired conditions that result in higher costs and take corrective action. 

Along with decreasing overall monetary expenditure from Medicare to hospitals for errors, the policy seeks to increase efficacy and quality of care by denying payments to hospitals for medical errors such as pressure ulcers, catheter-associated urinary tract infections, Staphylococcus aureus septicemia, air embolism, blood incompatibility, and retrieval of objects left behind in patients during surgery. There are seven more conditions that are under consideration which include ventilator-associated pneumonia, vascular catheter-associated infections, clostridium difficile-associated disease, methicillin-resistant staphylococcus aureus, surgical-site infections, wrong surgery, and hospital falls. Employer and consumer groups hope that private insurers will follow Medicare's example.

Initiators of idea/main actors

• Regierung: The new proposal is estimated to save at least $20 million dollars. Along with the cost saving, Medicare also hopes to increase the quality of care that patients receive.

• Leistungserbringer: Hospitals and physicians are the most negatively affected by the policy change. Although many believe that quality of care is important, they are wary that this may actually punish hospitals for events that are outside of their control.

• Kostenträger: Many private insurers will follow Medicare's lead on not paying for preventable medical errors.

• Patienten, Verbraucher: Beneficiaries believe the new proposal will significantly reduce the number of preventable medical errors. Second, they are relieved that the proposal prohibits hospitals from shifting the bills to the patients.

Approach of idea

The approach of the idea is described as:
new:
amended: By proposing to stop paying for preventable medical errors that occur in hospitals, the federal government is signalling that the high number of errors is unacceptable. This will not only increase the quality of care but will also save money.

Stakeholder positions

The rule was proposed by the Centers for Medicare and Medicaid services. The policy change that will come into effect on October 1, 2008, aims to decrease the number of preventable medical errors that occur by ceasing payments for hospitals. This will reduce the expenditure by $20 million and also seeks to increase the quality of care.

Medicare beneficiaries hope that the new change will actually result in higher quality of care by pressuring the hospitals financially. 

Physicians and hospitals agree with the overall goal of achieving high quality of care but believe that the policy may end up punishing hospitals for events that are outside of their control. Many physicians believe that this may be unfair since most doctors strive for the highest quality of care and do not intentionally bring harm to their patients. When harm is done, there are multiple recourses patients have at their disposal.

Actors and positions

Regierung
Centers for Medicare and Medicaid Services	sehr unterstützend		stark dagegen
Leistungserbringer
Hospitals	sehr unterstützend		stark dagegen
Physicians	sehr unterstützend		stark dagegen
Kostenträger
Private Insurers	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Medicare beneficiaries	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The new regulation will become operational October 1, 2008. This proposal is in response to the Medicare Modernization Act of 2003 which states that the Department of Health and Human Services (HHS) must select conditions that are acquired in hospitals and occur often. This change is mostly an aim to seek higher quality of care for patients and to decrease the overall costs spent by Medicare.

Legislative outcome

success

Actors and influence

Regierung
Centers for Medicare and Medicaid Services	sehr groß		kein
Leistungserbringer
Hospitals	sehr groß		kein
Physicians	sehr groß		kein
Kostenträger
Private Insurers	sehr groß		kein
Patienten, Verbraucher
Medicare beneficiaries	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

The strong push for increasing quality of care was in part due to the Institute of Medicine's report in 1999 on medical errors. The increased quality of care appeals to consumers and the general public, as well as physicians and hospitals. The large savings appeals to the government. The hospitals are most adversly affected in that the new policy would require them to collect more data before the patient is admitted to evaluate whether the condition was already present. Hospitals also argue that some of the conditions under the policy change are not entirely preventable.

Monitoring and evaluation

The success of this legislation can be evaluated by measuring the amount of "unnecessary" procedures that are performed after the implementation of the policy. Secondly, success can be evaluated in terms of how much money is saved.

Review mechanisms

keine Angaben

Results of evaluation

Not available

Expected outcome

The policy change is highly likely to reduce the number of adverse events during surgery and objects left behind during surgery, which will undoubtedly increase cost savings. However, instead of Medicare paying for preventable medical errors, the costs would be absorbed by hospitals. Hospitals will have to apply additional testing at patient admittance to test for pre-existing infections. Overall, the number of hospital errors should reduce significantly.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The policy change should significantly reduce the amount of preventable medical errors. All stakeholders believe that increasing the quality of patient care is important. Hospitals are concerned about whether the conditions that CMS deems as preventable medical errors are truly preventable. Hospitals fear that they will be penalized for conditions that are out of their control. Overall, this new policy change should have a positive outcome in reducing preventable hospital medical errors.

References

Sources of Information

Pear, Robert. "Medicare Says It Won'T Cover Hospital Errors." The New York Times, 19 August 2007. Accessed 7 September 2007.

O'Reilley, Kevin B. "Medicare Plans to Stop Paying for 6 Hospital-Acquired Conditions." AMNews, 18 June 2007. Accessed 21 September 2007. www.ama-assn.org/amednews/2007/06/18/gvsb0618.htm.

Zhang, Jane. "Medicare to Stop Paying for Some Hospital Errors." The Wall Street Journal, 20 August 2007. Accessed 8 September 2007. http://blogs.wsj.com/washwire/2007/08/20/medicare-to-stop-paying-for-some-hospital-errors/.

Author/s and/or contributors to this survey

Das, Kristina and Gerard Anderson

Johns Hopkins Bloomberg School of Public Health

Empfohlene Zitierweise für diesen Online-Artikel:

Das, Kristina and Gerard Anderson. "Hospital Errors No Longer Covered by Medicare". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/us/b10/1